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The greatest phenomenon that nature has known

In 1849 a Spanish journal, La crónica de los hospitales, published a case supposed to have occurred some forty years earlier in the Mexican port of Veracruz – at the time, a Spanish colony. It was recorded in private notes made in 1809 by Dr Faustino Rodriguez, a distinguished practitioner of the city, but for some reason had never been published by a reputable journal. The editor of La crónica noted that the extraordinary events of the case made him dubious as to its veracity, but hoped that putting it in the public domain might at least prompt some discussion. The headline translates as ‘A very unusual miscarriage’ – which barely does it justice:

In the city of Veracruz lived Maria de la Cruz, a native of Papantla, at 18 years of age, married to Juan Bautista de los Reyes: at 17 she became pregnant, and miscarried at three months; soon she became pregnant again for the second time.

The young woman obtained a position as a servant to a man called José Garcia, but in June she fell ill with what appeared to be a stomach complaint. She was visited by Professor Antiono Flores, surgeon to the fort of San Juan de Ulúa.

He found that she had a rapid, full and hard pulse, pain of the head, stomach and all extremities; thirst, frequent vomiting, and prostration of the strength. He was convinced that in addition to being poorly acclimatised she was also suffering from yellow fever.

The surgeon administered an emetic, which on the first of July resulted in powerful vomiting.

At half-past four in the afternoon she choked on an unusually massive foreign body which she eventually threw up. Her cries summoned her mistress Mariana de Guevara and her sister Guadalupe, who when they noticed this object in her mouth encouraged her to get rid of it, suggesting that it was a mass of worms. Unable to breathe, she seized the object with her fingers and pulled it out, throwing it into a spittoon. At this moment José Garcia came into the room; curious to see what had just happened, he picked up the basin and found a female foetus, perfectly formed, with all her limbs intact.

Shortly afterwards Professor Flores appeared. He was amazed when he was told what had happened, and – understandably – more than a little sceptical. He examined the patient, who told him that she believed that she had been pregnant for four months.

Professor Flores was still in attendance at 6 pm, the patient being very restless, when she vomited for the second time. When he picked up the basin this time he found that it contained the placenta with more than a span of umbilical cord.

A span is about 9 inches. The professor noticed that the young woman’s condition was deteriorating fast, and realised that the end was near. Sure enough, she died at half-past ten that night.

The following morning he and a colleague agreed that they needed to perform an autopsy to find out more about this perplexing case – despite the ‘disgusting’ state of the cadaver, which in the heat of the Mexican summer was already in an advanced stage of decomposition.

The uterus was found to be scirrhous…

‘Schirrhous’ is an archaic term which describes a type of cancer characterised by an abundance of fibrous tissue.

…and incapable of conception because its interior walls were consolidated.

A significant finding: the doctors believed that the woman had a cancer which rendered her infertile.

At the bottom of the vagina was an anomalous cavity, located between the uterus and the rectum, to which the membranes of the vagina were attached, with a hole four inches in diameter that communicated with the intestinal canal.

Intriguing. The doctors’ working assumption was that the foetus, amniotic sac and placenta had been formed in this space outside the womb. They examined the other internal organs, but found only one other thing of note. The small intestine, pyloric sphincter (the muscular valve between the stomach and small intestine) and stomach were unusually dilated.

Dr Rodriguez was laudably cautious in his conclusions, but was sure of one thing: fertilisation had taken place outside the womb (known as an ectopic pregnancy). This is, in fact, fairly common.

As to the possibility that the foetus had somehow found its way into the bowel and thence the stomach before being vomited, he was willing to say only that if it were true it was ‘the greatest phenomenon that nature has known’. Given the extreme implausibility of such a scenario, his assessment seems quite fair.